Presentation
Right shoulder chronic weakness
Patient Data
MRI of shoulder demonstrates gross bony destruction, and bony defects mimicking Hill-Sach's and Bankart's lesions were noted. In isolation, possibility of recurrent dislocation with septic arthritis was also considered. However, patient did not give any history of shoulder dislocation. Such a massive destruction strongly pointed towards neuropathic joint. And thus, MRI spine was done as additional study to rule out syringomyelia.
MRI of spine did confirm gross syringomyelia and mild cerebellar tonsillar herniation, may suggest Chiari malformation as antecedent etiology for neuropathic joint.
CT confirms bony debris in distended joint and bursae.
Case Discussion
Marked destruction of bones forming shoulder, with deformed humeral head, marked joint and bursal effusion were seen. Multiple loose bodies/debris seen in distended joint and bursae. Deformed humerus and glenoid does show defects mimicking Hill-Sach's posterolateral humeral defect, and inferior glenoid Bankart's-like lesion. There is also syringomyelia and mild cerebellar tonsillar herniation on spine images.
This case shows classical findings of Charcot Shoulder (Neuropathic joint).
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